Beginner's guide to GENDER: identity, dysphoria, transexualism, sex reassignment (addendum)

What is gender reassignment?

Gender reassignment is a long process. Although people’s chromosomes and reproductive identity can’t be altered, long-term hormone treatment and surgery should allow them the physical appearance and some of the sexual functions of the opposite sex. However, after surgery, they will lose the ability to have children.

A psychiatrist, GP or social worker can refer people wanting to have gender reassignment surgery to a recognised gender identity clinic. An evaluation for treatment will be based on a detailed history of a person’s childhood development through to puberty and afterwards.

The clinic will want to know everything about a person’s medical and personal history, current circumstances and general mental health and emotional stability. There may be further psychological assessments to clear up any unanswered questions.

Gender reassignment is not the right solution for everyone. It needs thinking about very carefully, and the clinic will actively pursue any possible alternatives to it.

Staff may well encourage people to pursue less drastic possibilities, after an initial assessment. These might include pursuing their chosen lifestyle without surgical intervention, or getting other forms of support, such as counselling or self-help groups.

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What does male to female gender reassignment involve?

Recognised gender identity clinics generally follow the guidelines and standards set out by the Harry Benjamin International Gender Dysphoria Association.

For a man wishing to become a woman, treatment would mean taking female hormones for at least one year before any irreversible surgery would take place. The hormones reduce body hair, cause breast development, and generally make the body shape and skin texture more feminine.

The person would also have to live as a woman, full-time, for a minimum of one year before any surgery can be authorised.

During this period, some transsexuals may choose to have facial hair removed by electrolysis, may undergo cosmetic surgery to make their face more feminine, or learn to raise the pitch of their voice.

When a patient feels ready, they may apply for medical approval of reassignment surgery. The clinical team will review the patient’s progress to see how well they’ve adapted to their new role, and depending on the results of this evaluation, surgery may then be approved.

Gender reassignment involves major surgery. Under general anaesthetic, the testicles and erectile tissue of the penis are removed.

An artificial vagina is then created and lined with the skin of the penis, where the nerves and blood vessels remain largely intact. Tissue from the scrotum is then used to create the labia, and the urethra is shortened and repositioned appropriately.

What does female to male gender reassignment involve?

For a woman wanting to become a man, taking the male hormone testosterone leads to beard growth and muscle development. On the whole, these changes can’t be reversed later.

As early as six months into this programme, it may be possible to have a mastectomy (breast removal). This makes it much easier for the person to appear as a man in public. After at least a year of hormone treatment, the ovaries and uterus are removed.

For many female to male transsexuals, this is as far as they will go with surgery. Going further is more complex, costly and difficult to achieve.

For those who do continue, phalloplasty (penis construction) and testicle implants are available. It’s also possible to create a male urethra and to move the clitoris to the head of the penis.

Gender reassignment, morality and the LAW!

Please be advised that in certain countries, gender reassignment is forbidden by law. In some parts of the world too, morality dictates that it is not always possible to do a gender reassignment surgery.

Please take a long time through counselling with professionals and open discussions with your family members and partners before even considering gender reassignment surgery. It not uncommon for some individuals to request to change the sex back to the original state...

...but by that time it would really be too late! In summary, gender reassignment even in the most tolerant world societies need to be considered with extreme care as the reprecussions are not just felt by the individual but by everyone around her or him.

* Refer to Stewart, G's (2004) accessible booklet entitled ‘Understanding Gender Dysphoria’ published by for a more complete picture of this complex issue.


This is but one posting in a series of postings regarding gender, gender dysphoria, gender identity disorder, male to female transexualism and the controversal issue of sex reassignment surgeries.

You might like to start your journey into gender discovery or affirmation by reading the concise but informative postings below (in chronological order). In time, more postings will follow!

Beginner's guide to GENDER part 1/2

Beginner's guide to GENDER part 2/2

Beginner's guide to GENDER (addendum)

Reitz Gender Test part 01 - Introduction

Reitz Gender Test part 02 - test items 1 to 16

Reitz Gender Test part 03 - test items 17 to 32

Reitz Gender Test part 04 - test items 33 to 48

Reitz Gender Test part 05 - test items 49 to 65

Reitz Gender Test part 06 - Typical Male classification

Reitz Gender Test part 07 - Feminine Male classification

Reitz Gender Test part 08 - Androgyne classification

Reitz Gender Test part 09 - Probable Transexual classification

Reitz Gender Test part 10 - Classic Transexual classification


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